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Matters of Life and Death

December 15, 2009 7:54 pmDecember 15, 2009 7:54 pm

On Monday, when it looked like Joe Lieberman’s refusal to vote for a public option (or anything remotely like it) might derail health care reform, Ezra Klein kicked up a hornet’snestof controversy by accusing Lieberman of being “willing to cause the deaths of hundreds of thousands of people in order to settle an old electoral score.” That “hundreds of thousands” refers to the number of Americans who die every decade because they don’t have health insurance — or rather, it refers to one study’s estimate of that number. Otherstudies, cited by Michael Cannon and John Goodman, suggest that the number is considerably closer to zero — or else that the link between health insurance and mortality might be too murky too penetrate. But of course there are still otherstudies that tend to confirm Ezra’s numbers …

Anyway, without trying to adjudicate these competing claims, I’ll just say that I would be very surprised if extending health insurance coverage didn’t have some positive effect on life expectancy for the newly-insured. And what’s more, I think liberals are absolutely right to be laying their emphasis on this point: It’s the best argument (and, indeed, increasingly the only argument) in favor of the current legislation. But I think Ezra’s missing the point when he acts puzzled that anyone who accepts his statistics would object to the way he went after Lieberman. Responding to his Post colleague Charles Lane, who accused him of being pointlessly “venomous,” he writes:

It seems, at this point, that our dispute comes down to tone. Lane wonders whether “it will be easier to achieve reform in an atmosphere where accusations of mass murder whizz about freely.” I wonder whether reform is even possible to achieve in an atmosphere where statements about consequences are ruled out of order.

Statements about consequences are not ruled out of order — but yes, the tone and language in which they’re delivered matters a great deal. In this regard, the claim that “health care reform will save lives” is very, very different from the statement that “opponents of health care legislation are willing to let hundreds of thousands of Americans die.” The two may be factually similar, but only the latter waves the bloody shirt. And the bloody shirt is the enemy of both reasonable debate and good lawmaking. It’s a conversation-killer, and a policy destroyer.

It kills conversations because everybody worth taking seriously on the contemporary political scene, left and right alike, thinks that their favorite mix of policies will maximize human flourishing. This is true in the health care debate, where plenty of highly-intelligent Obamacare opponents are convinced that greater government intervention in the health care system will cost many more lives in the long run than it saves in the short run. But it’s also true in political arguments more generally. Proponents of escalating our commitment in Afghanistan think their preferred policy will save lives in the long run; so do supporters of withdrawal.* Advocates of increasing our foreign aid budget think that American dollars can save Africans from disease and starvation; opponents think that Africans are worse off with foreign largesse than they would be without it. The Club for Growth thinks that free markets and low taxes will make the world steadily richer, healthier and happier; the Club of Rome thinks that unfettered growth will lead to global misery and mass starvation.

Every side of every debate, in other words, can plausibly accuse its opponents of being “objectively pro-death.” And they do: Conservatives did it withIraq, and now liberals are doing it with health care. But it’s a pointlessly polarizing style of argument. It doesn’t convince anyone who isn’t already convinced. It inclines people who might agree with you on substance — people like Charles Lane, in this case — to distance themselves from your rhetorical style. And it encourages your opponents to resort to the most extreme version of their own arguments, because how else can they one-up your reductio ad mortem?

Worse, it turns policymaking into a manichaean exercise, in which every “no” vote is a vote against the health and happiness of millions, and cost-benefit analyses give way to the fierce urgency of “now, or else.” The time for debate is always finished, the time to close ranks on the side of truth and justice is always upon us, and if you don’t vote for this bill, then people will die! If you think that a better health care bill might emerge from the wreckage of Obamacare, then you’ll have blood on your hands if nothing ends up passing. If you’re Joe Lieberman, it doesn’t matter that you have an opportunity to use your leverage to improve (by your own lights, at least) a gargantuan and costly piece of legislation; you’re “sociopathic,” in Matt Yglesias’s phrasing, if you don’t just go along with whatever compromise is on the table. (And if Lieberman’s a sociopath, what does that make Howard Dean?)

Again, this style of argument is not a distinctively liberal sin. But it is a sin, and I don’t think Ezra should be surprised that people reacted so angrily to his decision to inject a little more venom into an already too-venomous debate.

*Having cited the example of the Afghan War, I should allow that these sort of “your policy will kill people” arguments are more defensible in contexts — like a foreign war — where people are actually being directly killed, as opposed to just having their life expectancy reduced. (This allowance applies to domestic debates over the death penalty, euthanasia and abortion, as well.)

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About

Ross Douthat joined The New York Times as an Op-Ed columnist in April 2009. Previously, he was a senior editor at the Atlantic and a blogger for theatlantic.com. He is the author of "Privilege: Harvard and the Education of the Ruling Class" (Hyperion, 2005) and the co-author, with Reihan Salam, of "Grand New Party: How Republicans Can Win the Working Class and Save the American Dream" (Doubleday, 2008). He is the film critic for National Review.